June 16, 2003

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Legislature Takes A Breather after Enacting Dirigo Health Plan
The Maine Legislature recessed around 4:00am Saturday morning after enacting the Dirigo Health Plan. The House vote was 105-38 and the Senate 25-8 in favor of the bill.
Following a remarkable week of negotiations, the Maine Legislature has given final approval to the Governor's Health Plan.  The Report of the Joint Committee on Health Care Reform was unanimous, after Democrats agreed to make a number of changes to the bill called for by the Republicans.  The concessions granted to achieve the unanimous report included greater legislative oversite of the implementation of the plan, a revised plan for the establishment of a high risk pool, a study of the medical malpractice insurance market in Maine and the inclusion of a 12.5% floor for non-hospital projects in the CON pool.

Access to the language in the final bill can be obtained by going to Maine Medicine Political Pulse and clicking on 'View the Dirigo Health Plan Online or Download the Plan.'

Medicaid to Expand Prior Authorization/Preferred Drug List
The Bureau of Medical Services recently announced a major expansion of the MaineCare Prior Authorization program.  The Program was previously expanded in 2001.  In addition, the Bureau has announced several other initiatives aimed at curtailing up to $30 million in the drug program annually.  Included in the initiative is a process that will lead to some drugs (mostly injectable) being put out to a single vendor.

The June 4th Request for Proposal (RFP) describes in more detail the proposal which certainly has the potential to adversely impact patient care.  Because the timeframe is so short, MMA and other interested organizations will be requesting a delay in the July 1, 2003 deadline in order to give physicians and their staff the opportunity to fully assess the implications of the RFP and to investigate alternative solutions.

Physicians wishing to contact the Governor's office regarding the proposal may do so by writing to him at the Office of Governor, One State House Station, Augusta, Maine 04333-0001.

Training sessions on the Prior Authorization expansion are scheduled for this week in Portland, Augusta, Bangor and Presque Isle.Call the Help Desk at Gould Health Systems, 1-888-420-9711 or the MaineCare representatives at 1-800-321-5557 for more information.  MMA members may feel free to contact either Andrew MacLean or Gordon Smith at 622-3374.

While the Preferred Drug List is scheduled to go into effect on July 1, 2003, it will only initially affect new prescriptions written after July 1.  There will be a three-month grace period, during which refills of many non-preferred drugs already on file at the pharmacy will be honored without prior authorization. [return to top]

Senate Finance Committee Reports Out S. 1, the Prescription Drug and Medicare Improvement Act of 200
After years of debating the issue, last Thursday evening the Senate Finance Committee reported out a $400 billion package dealing with prescription drugs and Medicare reform.  The final vote was a strong 16 to 5.

In addition to providing a drug benefit to Medicare beneficaries, the bill also includes a provision limiting geographic indicies, a provision which has been :scored at $6.5 billion over ten years.

Strong regulatory relief provisions are also contained in the bill that reflect much of MERFA, legislation that was offered in the last Congress and strongly supported by the American Medical Association. 

Another positive provision in the bill includes a requirement that a carrier medical director be established in each state.

Also of note, Senator Kyle (R, AZ) offered an amendment that would provide positive physician updates for 2004 and 2005, by adopting MedPAC's recommendations regarding the physician reimbursements as a two-year nation-wide demonsration project.  Senator Kyle did withdraw the amendment without a vote in an attempt to keep the issue alive for this session.

S. 1 would require Medicare patients to pay a $35 monthly premium and a $275 yearly deductible before government subsidy begins.  The government would then cover half the cost of their medicine, to a maximum of $4,500 per year.  Once a patient's prescription costs reach $4500, the coverage would stop unless the total exceeds $5800.  At that point, 'catastrophic' coverage would begin again which would pay 90% of additional costs. [return to top]

Legislature Votes to Carry-over L.D. 1612 re: Fund for a Healthy Maine
In the waning hours of the session, both the House and Senate voted to commit L.D. 1612 to the Health Care Reform Committee where it is expected to be carried over to the Second Regular Session beginning in January 2004.

The action was necessary when it became clear that the votes were not there to give the bill a two-thirds vote in each chamber.  If enacted by a two-thirds vote, the bill calls for placing a Constitutional amendment on the ballot that would have the effect of protecting the fund and ensuring that every penny of the tobacco settlement money coming into Maine would be used for health-related purposes. [return to top]

WEDI Foundation Training Announcement
The Workgroup for Electronic Data Interchange (WEDI) Foundation and the Maine affiliate of WEDI SNIP (Strategic National Implementation Process) announce 'HIPAA Solutions; Achieving Compliance,' a one and one half hour HIPAA implementation seminar to be held on Monday, July 28 and Tuesday, July 29 at the Ramada Conference Center in Lewiston Maine.

For more information about the seminar registration and program content, please contact Ann Marie Railing, WEDI DIrector of Regional Education and Operations, 1-703-391-2717 or repstein@wedi.org. [return to top]

Monkeypox Outbreak in Wisconsin, Illinois, and Indiana
On June 7th, the Centers for Disease Control and Prevention reported cases of suspected monkeypox among residents of Wisconsin (7), northern Illinois (1), and northwestern Indiana (1).   Onset of illness among patients began in early May.  Patients typically experienced a prodome consisting of fever, headaches, myalgias, chills, and drenching sweats.  Roughly one-third of patients had nonproductive cough.  The prodromal phase was folllowed 1-10 days later by the development of a papular rash that typically progressed through vesiculation, pustulation, umbilication, and crusting.

All patients reported direct or close contact with prairie dogs, most of which were sick.

For the most up-to-date information on this outbreak, please visit the CDC's monkeypox web site at http://www.cdc.gov/ncidod/monkeypox/index.htm. [return to top]

Free Interactive Satellite Broadcast on Emergency Preparedness Available Wednesday
On Wednesday, June 18th, a free satellite broadcast about the roles and responsibilities in emergency preparedness at local, state and federal levels is being offered.  The program is from 9:00am to noon and is facilitated at 12 sites across the state.

While there are currently over 300 participants registered, there is still some seating available at some of the 12 sites.  Registration is available at http://www.mcph.org/signup.form6.03.html. [return to top]

For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association